Georg Ivanovas From Autism to Humanism - systems theory in medicine

4.6. Second-order cybernetics in medicine

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b) neuroscience and addiction

Neuroscience finds neurophysiological results. These results are as restricted as any other way of observing human nature. They are mainly instrument bound. The following examples of research in neuroscience are chosen because they are vivid and sometimes humouristic. Simultaneously they represent a general attitude.

New brain scanning studies have shown, that when you first fall in love, you are not experiencing an emotion, but a motivation or drive ... The early stages of a romantic relationship spark activity in dopamine-rich brain regions associated with motivation and reward. The more intense the relationship is, the greater the activity. The regions associated with emotion, such as the insular cortex and parts of the anterior cingulate cortex, are not activated until the more mature phases of a relationship... There are some differences between love-struck men and women... Women in love show more emotional activity earlier on in a relationship. They also seem to quiz their memory regions as they look at pictures of their partner, perhaps paying more attention to their past experience with them. For men, perhaps unsurprisingly, love looks a little more like lust, with extra activity in visual areas that mediate sexual arousal” (Phillips 2003d).

This result may not be valid as it was found in 7 male and 10 female volunteers. However, it shows some remarkable characteristics. First, the research does not provide new discoveries of human behaviour, as the kind of reaction is known to us. The scientists might only claim that they proved every-day knowledge, because they measured it. What the paper solved, however, is a problem that puzzled humans since thousands of years: “What is an emotion?” It is an activity of the insular cortex and parts of the anterior cingulate cortex. This answer is the answer of a method, better: of a machine. Many emotional processes can be mapped in such a way (Fisher 2004). A study answered the question “Does rejection hurt?” (Eisenberger et al 2003) with “yes”, as the same neuronal areas were active as in physical pain.

Such results do not create a new reality. They are, at first, but simple descriptions in a certain context. The next step would be to conclude that everything not in line with this definition is no love or pain, the metaphysical shift from description to prescription.

An example is the case of a women with an acute, bilateral occipital artery infarction with occipital lobe damage, leading to a Charcot-Wilbrand syndrome. As a result she lost her ability to dream. The claim that dreams are generated in the destroyed part of the brain is only a hypothesis to be proved, in the first place. But the conclusion that Freud’s concepts are wrong, because if dreams would have any meaning they would have been generated in the frontal lobe (Bischof/Bassetti 2004) is a typical fallacy through the metaphysical shift.

In fact, there is a lot room for fallacies. The reductionist context suggests a trivial correlation between a tested behaviour and the reactions in the brain. But things are far from being as simple. The same regions of the brain are active in romantic and maternal love (Bartels/Zeki 2004). However, they are also active in hate (Zeki/Romaya 2008). The difference between love and hate can be found (if the results are reliable) in the activity of other centres which are simultaneously active (Kawabate/Zeki 2008). That is, such emotions are a result of an interplay of factors, an emergent phenomenon (chap. 4.10), where a small change of the pattern might lead to a totally different outcome.

This can be demonstrated with other results of brain research. Different observers of a Western with Clint Eastwood showed the same activation pattern of the brain. The conclusion of the authors was that they see the same (Hasson et al 2004). Other studies show, however, that the hormonal response between men and women differs considerably, especially in seeing an action film (Schultheiss et al 2004). That is, they react differently seeing the same.

Again, we find that extremely difficult issues like ‘sameness’, ‘perception’ and ‘seeing’ have been defined in a way convenient for the machine. But we have really no idea in how far different genders and different persons ‘perceiving the same’ really perceive the ‘same’ and how ‘same’ it is. The look at the brain scan is not possibly not enough to judge.

Men, according to common opinion, are more interested and responsive to visual sexual stimuli. That can be measured by the amygdala response to certain sexual stimuli. Therefore, it was no surprise that the amygdala of men showed a stronger activation than women’s amygdala. However, women reported greater arousal (Hamann et al 2004). What does it mean when the brainwave activity is the same in men and women confronted with erotic images (Anokhin et al 2006)? This conflict between measurement and reported experience is not only prominent in brain scan.

Another problem with brain scan shall be demonstrated with a presentation at the Congress of the American Society of Neuroscience 2003. Holstege found that the female orgasm is characterized by an activity of the ventral tegementum (VTA) whereas the faked orgasm showed activity in different areas of the brain mainly responsible for motion. This is in so far meaningful as cats with destroyed VTA area lose their desire to mate. But PET scanning is bound to technical restrictions and the test persons had to lie without moving and had to reach orgasm within 40 seconds by genital stimulation (Simm 2003).

This might be seen as an extreme example from a moral point of view. Nevertheless, it is scientific according to the generally accepted criterion that it might be falsified (Popper 1972). It would be possible – as even caged animals have different sensory maps than under naturalistic conditions (Polley et al 2004) - to falsify the findings of brain scanning, showing, e.g. that other areas of the brain are active in pain, love or sex.

The problem arises when we go a little further and investigate the polycontextural pattern.

The ventral tegementum (VTA), active in orgasm, is also highly activated through injections of heroine. Consequently addicts often compare being high with an orgasm (Simm 2003). Other centres of the brain have other drugs. The nucleus acumbeus – a main centre of humour and laughing – is triggered by cocaine (Mobbs et al. 2003).

What is the next step after finding such relations? The measurements of the nucleus acumbeus “could help to diagnose the early stages of depression - or show whether antidepressants are taking effect - during which people’s appreciation of humour is altered. ‘That would be a terrific way to use this type of work’” (Pearson 2003).

We have here in a nutshell the principles of a medical paradigm: to diagnose depression by the reduced activity of a humour centre in the brain and to treat it with a cocaine like drug.

According to this logic, an effective therapy fulfils the criteria of the American Psychiatric Association for drug addiction (Camí/Farré 2003). That is, drug treatment becomes in line with drug addiction. Whereas the therapy for addicts aims to normalize the brain in a self regulative way (Goldman/Barr 2002), the machine based approach seems to facilitate addiction. Thus it is to no one’s surprise that addiction to prescribed drugs became a major problem in Western society. An official estimate says that about 1.4 – 1.9 million people in Germany became addicted to some kind of pharmacological drugs after treatments (Bätzing 2006) and more people die from legal drugs than from illegal (Statistisches Bundesamt 2008). This number does not included people who are lifelong treated for symptoms and diseases where an unspecific or natural therapy would be possible.

In a climate where every unease or disease is treated with a drug (which might be highly effective in a certain frame of observation), it is not astonishing that already adolescents have a high consumption of cannabis and hard drugs (Leurs et al 2004, Bellis et al 2008). A society which treats everything with drugs has, of course, a drug problem. And it sounds like an irony that even addiction shall now be treated with drugs (Thyer 2006).

A second-order analysis has to provide such insights like how the observer (in using the machine) comes to certain results (definition of love, orgasm, humour and depression), and how these results might lead to a certain therapy (similar to drug addiction). Other ways of perceiving medical process come to other definitions leading to other therapies with other medical and social impacts. For example if depression would be seen mainly as a social phenomenon, its therapy would be totally different.


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